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CMS2 > Salivary glands 2 > Flashcards

Salivary glands 2 Flashcards

1
Q

How much saliva is produced in total and what % is from each salivary gland

A

1L/ day

70% parotid
25% submandibular
5% sublingual and minor salivary glands

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2
Q

What are the components of saliva

A
  • Water, Nacl,HCO3(Buffer)
    -Enzymes: amylase, lysoszyme, perioxidase
  • Immunoglobulins (IgA- secretory antibiody for mucosal immunity)
    (IgG related to systematic immunology)
    pH= 8
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3
Q

where is saliva produced?

A

acini

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4
Q

What cells are present in acini

A

serous (produces thin watery- parotid)
mucus (produces thicker mucus - sublingual)

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5
Q

Where is saliva stored

A

in ducts- vary in size & drain towards duct orifices

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6
Q

What type of saliva is produced by the parotid

A

thin watery saliva (serous> mucus)

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7
Q

What type of saliva is produced by sublingual gland

A

thick mucus

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8
Q

What type of saliva is produced by submandibular

A

Serous= Mucus

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9
Q

What do salivary glands contain

A
  • Vessels
    -Lymphatics
    -Lymphoid tissue
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10
Q

What are salivary glands controlled by & how is it stimulated

A

Parasympathetic (most of flow of saliva) and sympathetic nervous system (composition)

trigger: taste/ smell stimulates salivary nuclei
- trigger causes salivary glands to produce saliva in rest and digest

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11
Q

What is the neurone pathway for submandibular gland stimulation

A
  1. Salivar nucleus
  2. Chorda Tympani (Vii- also carries taste)
  3. Lingual nerve
  4. Submandibular ganglion
  5. Submandibular gland
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12
Q

What is the neurone pathway for parotid gland

A
  1. salivary nucleus
  2. IX- glossopharyngeal
  3. Otic ganglion
  4. Parotid
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13
Q

What is the mechanism for salivary glands acini to produce saliva

A

Cholinergic nerurotransmission: similar to neuromuscula junction
- acetylcholine is released into space between end plate and receptor
- ActH binds to receptors trigger intracellular processes (causing release of saliva)

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14
Q

How can excess saliva be treated?

A

Botulinum toxin (botox- typically used to reduce appearance of wrinkles and muscle spasms)- less saliva is produced

  • central inhibition (antimuscarinic effect) e.g antidepressants
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15
Q

When is excess salivia considered ‘normal’

A

Normal drooling :when children, when sleeping, in reduced consciousness, dementia, learning difficulties, head and neck surgery/ pathology

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16
Q

What is the consequence of excess saliva

A

eczema/ skin rash (due to bacteria/ enzymes)
management: treating eczema & keeping skin free from saliva

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17
Q

What conditions are associated with true excess saliva

A
  • drug poisoning
  • Parkinsons
    -Myasthenia gravis (neurological problem treated with cholinesterase inhbition- more acetyl choline is present at the nerve junction and so stimulates saliva
  • psychosis
    -dementia

poisons: mercury, insecticides, heavy metal, nerve agents

sore mouth: lumps, ulcers- trigger salivary nuceli

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18
Q

What are the causes of a dry mouth and how is a dry mouth measured?

A

Causes of dry mouth: anxiety, dehydration, drugs, salivary gland damage

assessed by Challecombe scale

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19
Q

What drugs cause a dry mouth

A

antidepressents (nortiptyline, amitrypts)
- antihistamines
-diuretics
-PPis

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20
Q

What are causes for Salivary gland damage

A
  • sjogrens syndrome
    -radiotherapy
    -sarcoidosis
    -HIV
    -Hep C
    -Cystic fibrosis (affect secretions)
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21
Q

What is saliva like in cystic fibrosis patients

A

Less watery saliva and more mucousy

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22
Q

What are the consequences of a dry mouth?

A
  • Mechanical (affects swallowing, speech, denture wear and debris in mouth)

-loss of taste
-caries & periodontal disease

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23
Q

What oral problems (diseases/ features) are associated with a dry mouth

A
  • dry lobulated tongue
    -Angular chelitis
  • Candidiasis (erythematous thrush/ discomfort/ taste chabge)
  • caries, perio, lack of taste
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24
Q

How do you investigate a dry mouth?

A
  1. Clinical examination (is the mouth dry)
  2. Diagnosis of why it is dry
    - 3 months+ of a dry mouth suspect sjogrens
25
Q

How can you objectively assess the level of saliva produced?

A
  1. Saliva flow rate ( see in a cup how much saliva they produce)
  2. Stimulated parotid saliva- Use carlson-crittenden cup (sits over parotid)
    Stimulate saliva with citric acid on tongue
26
Q

What imaging techniques can be done to investigate saliva production

A

Sinalography:
Use dye to see salivary glands- stones can be seen

Ultrasound : bounce soundways off tissues
Water Filled can pass sounds ways easily through them→ stones can be see,
Stricture of duct: thinner and more constricted

27
Q

What is meant by Punctate sialectasis and how can it be detected

A
  • balls of dye at end of tree of salivary ducts)
  • Sign of sjogren’s disease
  • can be seen via sinalography & ultrasounds
28
Q

What is primary sjogrens syndrome?

A

dry mouth and dry eyes, no connective tissues disease (RA/ CTD/ SLE )

29
Q

What is secondary sjogrens syndrome?

A

Secondary sjogrens syndrome: dry mouth, dry eyes, autoimmune disorder RA/ CTF/ SLE

30
Q

What is the cause of sjogrens syndrome & incidence?

A

Autoimmune disease causing destruction of salivary acini- Autoantibodies produced by the body

Can affect other tissues (glandular tissues)

Incidence:
50 per 100k
F:m = 10:1
Peak age of 50-60 years
HLA association: as connective tissues

31
Q

How is sjogren’s syndrome diagnosed?

A

Oral symptoms:
- dry mouths daily 3/12 m
- Persistent/ recurrent salivary gland swelling
- Need to take water to swallow

Eye symptoms→ dry eyes daily 3/12m
-sand/ grit sensation in eyes
- Tear substitutes/ drops >3/day

Objective criteria
Salivary flow
Schirmer test: tears on blotting paper, measure speed tears flow down
scarring/ ulceration of cornea

Auto-antibodies
Labial gland biopsy: looking for focal inflammation infiltrate

32
Q

What are the complications of sjogrens syndrome?

A

dental complications: reduced QoL, Caries, perio

eyes: scarring & reduced vision

lymphoma: 5% risk of lymphoma

33
Q

What is the management of dry mouth/ salivary glands obstruction

A
  • Advise to see ophthalmologist
  • Educate lymphoma risk
  • Specialist referral
34
Q

How can symptoms of sjogrens syndrome be managed

A
  1. Diet, Fluoride, OHI
  2. Manage fungal/ bacterial infectionsm
  3. Stimulate Saliva
  4. Sugar free sweets/ chewing gums
  5. Sialogogues: pilocarpine
  6. Artificial saliva
35
Q

What are the causes of mechanical blockages of salivary glands

A

Stone/ strictures→ due to protein/ minerals together
- Most commonly submandibular
- Usually affect one gland at a time
-Saliva flow cannot escape and increase pressure causing swelling

36
Q

How can salivary gland blockages be investigated

A

Investigate if occurs during meal times (on tasting/ thinking of food)
- O/E: no saliva draining from duct when message, feel stones in the floor of mouth
- X-rays can show up

37
Q

What are the treatment options for salivary gland blockages

A
  • Papillotomy:
  • Duct dilation via lacrimal probes:
  • Basket retrieval:
  • Sialography:
38
Q

What is meant by Papillotomy

A

ncision at duct orifice to extract

39
Q

What is meant by Duct dilation via lacrimal probes

A

indications : if duct is too small
Introduce lacrimal probes (smallest to largest)

40
Q

What is meant by Basket retrieval

A

indications: if stones are further back
-Sialendoscopy is introduced into duct, stone is trapped by basket and removed out

41
Q

What is meant by Sialography

A

pump small volume of liquid under pressure, dislodge stone

42
Q

What are the causes of acute infections of salivary glands

A

Caused by Reduced salivary flow rate:
- Less saliva, reduced pressure gradient, bacteria can move from mouth into salivary orifice into gland causing an infection

43
Q

Who do acute salivary gland infections affect?

A

Elderly, young, dehydration

44
Q

What are the symptoms of acute infections of salivary glands

A

Feel acutely unwell, high temperature, raised WCC, swelling over gland, hot, red swelling

45
Q

How are acute infections of salivary glands treated

A

rehydrate, analgesia, antibiotics

46
Q

What are the symptoms of chronic infections of salivary glands

A

little/ no symptoms, recurrent swelling, pain, affect at meal times due to scarring
Each time occurs, more scarring

47
Q

How are chronic infections of salivary glands treated

A

supportive (removal of glands parotidectomy, remove damage gland), antibiotics, surgery: difficult due to scarring

48
Q

What is sialosis & its causes

A

Painless swelling of the glands (usually parotids & bilateral)
Causes: diabetes, alcohol, drugs

49
Q

How is sialosis treated?

A

Treatment not necessary, remove gland

50
Q

What is a cyst?

A

pathological epithelial lined cavity

51
Q

What are the 2 types of salivary gland cysts

A
  1. Mucus retention
  2. Mucus extravasation
52
Q

What is a mucus retention cyst?

A

blockage of salivary gland within gland/ duct minor glands

53
Q

What is a mucus extravasation cyst?

A

escape of saliva from traumatised gland/ ducts minor glands/sublingual

54
Q

What is a ranula & what is the appearance

A

-occurs in floor of mouth
Non-developmental cysts
Looks like a frog belly (latin for frog)
Appearance: Blueish, firm, feel full of fluid, round and smooth, floor of mouth

55
Q

What is a plugging ranula & what is the appearance

A

(extends through mylohyoid muscle into neck)
Neck swelling
Has 2 elements: intra-oral and extra-oral
Extra-oral: in the neck

56
Q

What is the treatment of a plugging ranula

A

remove intra-oral/ extra-oral element
Operation on mouth / neck
If do one it will come back

57
Q

How can you differentiate between mucus retention/ extravasation cysts

A

cannot tell unless remove

58
Q

What is a lip mucocele?
- what is the appearance?

A

blockage of minor salivary gland
-occur lower lip
- if upper maybe minor salivary gland tumour

appearance: painless soft fluid filled swelling, may appear bluish

59
Q

What is the treatment for lip mucoceles?

A

Cryotherapy: (CO2/ liquid nitrogen to cool down probe end), forms iceball, ice crystals within tissues form, crystals burst cells and damage them, cyst is destroyed

Excision: cut in the lip, risk of recurrence, scar/ swelling/ bleeding/ bruising

CMS2 (29 decks)

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